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Gasification of biomass in supercritical water is a successful technology for hydrogen production especially by using wet biomass. The whole process, from feeding to purification of hydrogen, consists of a lot of equipment, such as pumps, heat exchangers, heaters, reactors, etc. Because the main reactions take place in the gasification reactor, the gasifier is the most important equipment of the process. In this article, a thermodynamic model, including chemical equilibrium in the reactor that is based on Gibbs free energy minimization, is developed to estimate equilibrium composition for gasification of biomass in supercritical water for hydrogen production. For this analysis, we use three types of equations of state, including Peng-Robinson, statistical associating fluid theory equation of state, and a new equation of state. We consider glucose as a model of real biomass. The results of each equation of state are compared with the experimental data. The predicted results show good agreement with the experimental data and it shows that the product gases consist of hydrogen and carbon dioxide more often and methane and carbon monoxide less often. Finally, effects of temperature, pressure, and feedstock concentration are investigated on amount of hydrogen production. [ABSTRACT FROM AUTHOR]

Progressive periodontal disease in leukocyte adhesion deficiency children may lead to severe systemic infections and even death. A five-year-old Iranian male child with leukocyte adhesion deficiency I was first seen in December 2005 at the Pediatric Dentistry Department of Shahid Beheshti Medical University and diagnosed with periodontitis as a manifestation of systemic disease. The treatment approach was based on assessing plaque index, oral prophylaxis, periodic supra and subgingival scaling, in addition to strict oral hygiene instruction with a chlorhexidine prescription and restoration of decayed teeth. The patient attended two dental visits at a one month interval. At the second session, an improvement was seen in the plaque index. Gingival inflammation and bleeding were decreased. Unfortunately he did not regularly attend treatment sessions and at the following examination, progression of periodontitis and bone destruction occurred. The present case emphasizes the need for cooperation between medical and dental professionals, parents and the pediatric patient in order to achieve treatment goals in controlling oral infection in these patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: Hairdressers are exposed to various irritating chemicals during work. OBJECTIVE: This study was designed as a case-control study to evaluate the risk of developing obstructive lung disease in relation to occupational exposures in hairdressers. METHODS: We interviewed a cohort of 50 female hairdressers and 50 matched controls recruited from a random sample of the general population, using a validated questionnaire for occupational respiratory disease, to compare the prevalence of work-initiated and work-related respiratory symptoms in both groups. We also performed pulmonary function tests (PFTs) in all participants. RESULTS: Almost half of the hairdressers reported work-initiated respiratory symptoms. Cough (33%) and breathlessness (29%) were the most common self-reported symptoms after chemical exposures. All respiratory symptoms (cough, breathless, wheezing, and phlegm) were significantly higher in the hairdressers than in the control group (P < .001). The hairdressers reported that bleaching powder and hair spray were the most irritant chemicals that provoke their respiratory symptoms. The impaired PFT values (forced vital capacity, FEV(1), maximum mid-expiratory flow, peak expiratory flow) in the hairdressers, compared to the matched controls, were in line with the questionnaire data. CONCLUSIONS: Hairdressing work is associated with a high frequency of work-initiated respiratory symptoms and, to a lesser extent, with allergic symptoms, particularly after exposure to bleaching powder and hair spray. PFT values were significantly lower among the hairdressers, which might be a predictor for developing obstructive lung disease. [ABSTRACT FROM AUTHOR]

Introduction: Increasing old age and frailty is putting pressure on health services with 5– 10% of patients attending the emergency department (ED) and 30% of patients in acute medical units classified as older and frail. National Health Service improvement mandates that by 2020 hospital trusts with type one EDs provide at least 70 hours of acute frailty service each week. Methodology: A two-week pilot (Monday–Friday 8 am-5 pm) was undertaken, with a “Front Door Frailty Team” comprising a consultant, junior doctor, specialist nurse and pharmacist, with therapy input from the existing ED team. They were based in the ED seeing patients on arrival, referrals from the ED team and patients in the ED observation ward—opposed to the usual pathway of referral from the ED team to medical team. Data was captured using “Cerner” electronic healthcare records. A plan, do, study, act methodology was used throughout with daily debrief and huddle sessions. Results: 95 patients were seen over two weeks. In the over 65 s, average time to be seen was 50 minutes quicker than the ED team over the same period, with reduced admission rate (25.7% vs 46.5%). The wait between decision to admit and departure was shortened by 119 minutes. Overall, this led to patients spending on average 133 minutes less in the ED. 64 patients were discharged, of which 44 had community follow-up (including 37.5% of 64 referred to acute elderly clinic and 25% to rapid response). 47 medications were stopped across 25 patients. Conclusion:The pilot shows that introduction of an early comprehensive geriatric assessment in the ED can lead to patients being seen sooner, withmore timely decisions over their care and reduction in hospital admissions. It allowed for greater provision of acute clinics and community services as well as prompt medication review and real time medication changes. [ABSTRACT FROM AUTHOR]

Introduction: 2.5 million people in the UK are aged over 80 and up to 50% can be considered frail. Complex co-morbidities and polypharmacy are linked with adverse drug effects and negative outcomes. NICE recommends a medication review yearly, and a hospital admission provides an opportunity for this. STOPP-Frail is a screening tool designed to highlight medications that could be reduced/stopped with a view to improving quality of life. We conducted a quality improvement project to quantify levels of inappropriate prescribing at Croydon University Hospital (CUH), with a view to de-prescribing and reducing adverse drug effects. Methods: A retrospective analysis was carried out on the Elderly Care wards at CUH. Data was collected from 60 consecutive patients discharged from 1st November 2018, utilising electronic Cerner records. Recorded medication on admission and discharge, noting any amendments in accordance with the STOPP-Frail criteria. Results: Data collected from 60 patients; one exclusion for not meeting STOPP-Frail criteria (n=59). Median age 86 years (69 to 103 years). Mean number of medications on admission 7.42 (1 to 15). 93.2% patients had polypharmacy (defined as ≥ 4 medications). Mean number of medications on discharge 8.22; an increase of 0.8/patient. 19.4% admission medications met STOPP-Frail criteria for inappropriate prescriptions. Only 18.8% of these were reduced or stopped during admission. Gastrointestinal and cardiovascular medications were most commonly inappropriately prescribed (n=27 and 24 respectively). Most common medications not amended were lipid-lowering therapies (n=21) and proton-pump inhibitors (n= 20). Conclusions: The opportunity to rationalise medication in the frailest patients admitted to CUH is missed in over 80% of cases. STOPP-Frail provides clear guidance to aid clinicians in reducing inappropriate prescribing. An educational programme is in place to highlight medication rationalisation and guide clinicians in the use of the STOPP-Frail tool. This includes doctors’ induction, departmental teaching, posters and computer flash cards. [ABSTRACT FROM AUTHOR]

Context Every government implements various policies to mitigate road traffic injuries (RTIs). Many of these interventions are performed by traffic police. To evaluate effectiveness and efficiency of police enforcement, numerous studies have been conducted. Potential capabilities of epidemiology could get opportunity to improve these studies. The aim of this study was to extract and discuss some related methodological points of traffic police effectiveness and efficiency from related studies, in view of epidemiology discipline. Evidence Acquisition Related articles were searched with “traffic police”, “effectiveness”, “efficiency” and “road safety” keywords in ScienceDirect, PubMed and Safetylit databases. Related papers were selected and read carefully to summarize and discuss the epidemiological points with aims of giving clues to improve quality of studies. Results From a total of 797 articles, 20 were eligible which among them 17 articles were about effectiveness and 3 of them were about efficiency evaluations. Discussed points were the method of study, taking a holistic view to all positive and negative side effects, desired inputs and outputs, relation pattern between police enforcement and outcome and potential confounders. Conclusions Better understanding of the effectiveness and efficiency mechanism and having valid evaluation required considering specific theories and points in this field. Applying a dynamic approach with considering epidemiological concepts and sophisticated statistical models could improve quality of studies in this field.

Background Road traffic injuries (RTIs) are the main causes of death and disability in Iran. However, very few studies about the temporal variations of RTIs have been published to date. Objectives This study was conducted to investigate the temporal pattern of RTIs in Iran in 2012. Materials and Methods All road traffic accidents (RTAs) reported to traffic police during a one-year period (March 21, 2012 through March 21, 2013) were investigated after obtaining permission from the law enforcement force of the Islamic Republic of Iran. Distributions of RTAs were obtained for season, month, week, and hour scales, and for long holidays (more than one day) and the day prior to long holidays (DPLH). The final analysis was carried out using the Poisson regression model to calculate incidence rate ratios for RTIs. All analyses were conducted using STATA 13.1 and Excel software; statistical significance was set at P < 0.05. Results A total of 452,192 RTAs were examined. The estimated rate of all accidents was 219 per 10,000 registered vehicles, or 595 per 100,000 people. About 28% of all RTAs, and more than one third of fatal RTAs, occurred during the summer months. The incidence rate for all traffic accidents on DPLH was 1.20, compared to workdays as a reference category, and it was 1.40 for fatal crashes. The rate of fatal road traffic accidents in outer cities was 3.2 times higher than in inner ones. Conclusions Our findings reveal that there are temporal variations in traffic accidents, and long holidays significantly influence accident rates. Traffic injuries have different patterns on outer/inner city roads, based on weekday and holiday status. Thus, these findings could be used to create effective initiatives aimed at traffic management.

Background and Objectives: Painting workshops are part of the woodwork (carpentry) industry in which despite advances in technology, the work force fulfills most of the roles in the production process. Since such manual activities are often performed with awkward postures due to lack of workers’ awareness and inappropriate design of tools and working conditions, ergonomic assessment of work environment and working condition improvement seems essential. Designing evaluation checklist and calculating ergonomics indexes can be useful in this assessment. This study was conducted on workers of painting workshops of furniture industry with the objectives of a) evaluation of level of exposure to musculoskeletal disorders (MSDs) risk factors and b) determination of action category levels in the workshops.Methods: After conducting task analysis in the painting workshops, 47 workers were assessed by the designed ergonomic checklist and ergonomic indexes were calculated. Finally, the risk factors were determined. Ergonomics indexes were considered as the criteria to demonstrate the workshops ergonomic conditions and to determine action category for working condition improvement. Nordic musculoskeletal disorders questionnaire was also applied to determine prevalence rate of MSDs among workers. Data were analyzed using statistical tests including t-test and test of proportion.Results: Mean of age was 28.78 (range=17-58). The highest prevalence was reported in lower back (38.3%). Statistical analysis revealed that there were significant associations between occurrence of MSDs and calculated ergonomics indexes (P

AbstractBackground and Purpose: Various abnormalities of the immune system have been demonstrated in patients with chronic kidney disease (CKD). Patients with CKD commonly present with abnormalities of immune function related with impaired kidney function and the accumulation of uremic toxins. Th1 and Th2 cells produce predominantly some cytokine profiles. The aim of the present study was the determination of the levels of IL-13 and IFN- in sera of end-stage renal disease. The correlations of IL-13 and IFN- levels with clinical presentation of the disease were assessed.Materials and Methods: In this case-control study the serum levels of IL-13 and IFN- were determined by a sandwich enzyme-linked immunosorbent assay in 30 patients on hemodialysis (HD), 30 patients with chronic renal failure (CRF), and 60 healthy individuals . Renal function was evaluated by measuring serum levels of creatinin, albumin and urea.Results: The serum levels of IL-13 and IFN- were differed significantly between patients and healthy controls. The serum levels of IL-13 was significantly increased in the HD group than in the CRF and control groups (13.7± 3.9, 6.7± 3.4, 4.5±3.3 pg/ml, respectively) (P=0.001). On the other hand, the IFN- plasma levels were significantly higher in CRF patients than HD patients and controls (38.8±18.8, 17.4±8.78, 12.5±8.9 pg/ml, respectively).Conclusion: In the HD patients, low production of IFN- in line with upregulation of IL-13 indicates that Th1/Th2 balance may shift towards Th2 dominance. It is possible that this imbalance contributes to the abnormality of the immune system in HD patients.Key words: Chronic renal failure, IL-13 and IFN- , HeamodialysisJ Mazand Univ Med Sci 2008; 18(63): 37-45 (Persian)

Multiple sclerosis (MS) is a chronic inflammatory immune-mediated disease of the central nervous system. Despite extensive investigations, many aspects of etiology and pathophysiology remain unclear. In multiple sclerosis patients, immune system reacts against autologous proteins in the myelin membrane. Most evidences support the hypothesis that both genetic and environmental factors contribute to disease development. But after the failure of genetic findings to explain the reason for the unequal incidence of MS in identical twins, investigators focused further on environmental factors such as vitamin D deficiency, smoking, living in different latitudes and perhaps the most importantly the role of viruses in people whom are genetically susceptible to MS. There is increasing evidence that viruses may play important role in MS pathogenesis following environmental triggers. Recently, studies focused on the role of herpes virus family, especially Epstein- Barr virus, human herpes virus 6 (HHV-6) and Varicella Zoster virus, as the virus is prevalent in society. This review mainly focused on the identification of important viruses with key role in MS the mechanism behind pathogenesis and describes the animal models of MS. The results of researches are shown strong evidence of the virus or antibodies to viral components in active plaques in MS affected patients, but still cannot be stated with certainty that one or more specific viruses are simultaneously trigger the disease. Further studies are required to prove the pathogenesis of viruses in MS. [ABSTRACT FROM AUTHOR]

Background: Unplanned admissions for older people can result in lengthy hospital stays. It has been recognised that many of these admissions are avoidable, often associated with adverse patient outcomes and potential resource misappropriation.There is a drive to seek novel processes to better assess and manage frail elderly people presenting to Emergency Departments (ED).Innovation: Within a busy London District General Hospital, an Acute Care of the Elderly (ACE) service was designed. Based in the ED Observation Ward this service provides an in-reach service to the ED, and liaison to the Acute Medical Unit.This is a consultant-led service, with support from a trust grade junior doctor and Band 6 nurse. At present this is a weekday in-hours resource. Comprehensive geriatric assessment is delivered to patients over the age of 80, with complex problems or frailty, but who do not require inpatient care. Therapies and social care support is provided through existing teams operating in the ED.Evaluation: Between January and October 2013, 662 patients have been assessed by the ACE team, in whom 459 inappropriate admissions were avoided. To receive a comprehensive geriatric assessment and appropriate treatment to facilitate discharge of these patients only needed to stay an extra 4.76 hours on average in hospital.Since the introduction of the ACE service the rate of admission in older people from ED Observation Ward has reduced 61.2% in 2012 to 35.1% this year, despite similar levels of activity. Comparing similarly aged patients and episode diagnosis coding, in excess of 4,200 bed days could be saved per year.Conclusions: The ACE service has provided clear benefits to patients and the trust by avoiding un-necessary hospital admission, while providing focused consultant-delivered care in a timely manner. Expansion to a seven-day service is imminent, with expected further benefits. [ABSTRACT FROM AUTHOR]